Abstract
ObjectivesThe aim of the present study was to evaluate the prevalence of polycystic ovary syndrome (PCOS), its phenotypical and cardio-metabolic features in a community sample of the Iranian population in comparison to healthy eumenorrheic, non-hirsute women without polycystic ovaries. The second aim was to assess the cardio-metabolic characteristics of women who suffered from one criteria of PCOS compared to those healthy eumenorrheic, non-hirsute women.MethodsIn this cross-sectional population-based study, a total of 1,960 eligible women, aged (18–45 years) were recruited from the Tehran-Lipid and Glucose-Study participants and were classified as the three groups of (i) women with PCOS by the Rotterdam criteria, (ii) non-PCOS women with one criteria of PCOS and (iii) healthy eumenorrheic, non-hirsute women without polycystic ovaries morphology (PCOM) as the control group. Further PCOS women were extended to four phenotypes of hyperandrogenism, oligo-anovulation, polycystic ovaries (phenotype A), hyperandrogenism, oligo/anovulation (phenotype B), hyperandrogenism, polycystic ovaries (phenotype C) and oligo-anovulation, polycystic ovaries (phenotype D). Cardio-metabolic profiles and the prevalence of comorbidities of metabolic syndrome (MetS) and lipid abnormalities were compared among these groups linear, and the median regression models adjusted for age and body mass index.ResultsThe prevalence of PCOS according to the diagnostic criteria of the NIH, Rotterdam and AE-PCOS Society were 13.6, 19.4, and 17.8, respectively. Among those who met the Rotterdam criteria, 23.9, 46.3, 21.6, and 8.2% had phenotypes A, B, C, and D, respectively. Among the remaining 1,580 women who did not fulfil the PCOS criteria, 108 (6.8%) suffered from only oligo/anovulation, 332 (21%) only hyperandrogenism/hyperandrogenemia, 159 (16.2%) only PCOM in ultrasound and 981 (62%) were healthy eumenorrheic, non-hirsute women without PCOM. The study revealed that some adiposity indices and lipid abnormalities in PCOS phenotypes with hyperandrogenism (A, B, and C) were worse than in healthy women. By contrast, women with phenotype D did not differ from the healthy ones in terms of adiposity and lipid abnormalities. However, the respective values for other cardio-metabolic profiles and MetS rates in different phenotypes of PCOS were similar to the healthy women. Only the prevalence of MetS in phenotype A was significantly higher than in the healthy women. There were no statistically significant differences between participants with one criteria of PCOS and healthy counterparts in terms of most adiposity indexes, cardio-metabolic factors, and comorbidity of MetS and its components. However, women with hyperandrogenism had a significantly higher level of the waist to height ratio (WHtR) and hypertriglyceridemia than their healthy counterparts.ConclusionPCOS, mainly classical phenotypes A and B, are common among Iranian women of reproductive age. Women with PCOS who had androgen excess exhibited the worst lipid profile, and those who had full three criteria of the syndrome exhibited the higher rate of MetS. However, women with only ovulatory dysfunction and only PCOM had similar cardio-metabolic characteristics, compared to healthy subjects. These data suggest that routine screening for metabolic disturbances may be needed in the prevention of cardio-metabolic disorders in patients with more serious phenotypes of PCOS.
Highlights
Polycystic ovary syndrome (PCOS) is the common endocrine disturbance worldwide, affecting 6–12% of women of reproductive age [1]
Using different diagnostic criteria of PCOS, namely, the National Institutes of Health (NIH) [7], the 2003 Rotterdam [8, 9], and the Androgen Excess Society (AES) [10] definitions could potentially affect the estimation of PCOS prevalence [11]
The prevalence of PCOS according to the diagnostic criteria of NIH, Rotterdam and AE-PCOS Society were 13.6% (267/ 1,960), 19.4% (380/1,960), and 17.8 (349/1,960), respectively
Summary
Polycystic ovary syndrome (PCOS) is the common endocrine disturbance worldwide, affecting 6–12% of women of reproductive age [1]. The syndrome is a complex and heterogeneous disorder that may have various clinical manifestations, mainly including hyperandrogenism and/or hyperandrogenemia (HA), oligo/anovulation (OA) and polycystic ovaries morphology (PCOM) [2, 3]. Using different diagnostic criteria of PCOS, namely, the National Institutes of Health (NIH) [7], the 2003 Rotterdam [8, 9], and the Androgen Excess Society (AES) [10] definitions could potentially affect the estimation of PCOS prevalence [11]. According to the Rotterdam criteria, women with PCOS can be divided into 4 phenotypes [12]. The lack of standard approaches in diagnostic elements within each set of criteria, such as diagnosing oligo/anovulation and androgen excess and a technical issue in PCOM assessment, potentially impacts prevalence estimates of PCOS [13]. The handling of systemic hormonal contraception and its effect on PCOS manifestation is another issue that should take account
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